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CHAPTER 21 Nola J. Pender 401

model identifies concepts relevant to health-promoting
Use of Empirical Evidence behaviors and facilitates the generation of testable
The HPM, as depicted in Figure 21–1, served as a hypotheses (Pender, Murdaugh, & Parsons, 2002).
framework for research aimed at predicting overall The HPM provides a paradigm for the develop-
health-promoting lifestyles and specific behaviors ment of instruments. The Health Promoting Life-
such as exercise and use of hearing protection (Pender, style Profile and the Exercise Benefits-Barriers Scale
1987). Pender and colleagues conducted a program (EBBS) are two examples.* These instruments
of research funded by the National Institute of Nurs- serve to test the model and support further model
ing Research to evaluate the HPM in the following development.
populations: (1) working adults, (2) older commu- The purpose of the Health Promotion Lifestyle
nity-dwelling adults, (3) ambulatory patients with Profile instrument is to measure health-promoting
cancer, and (4) patients undergoing cardiac rehabili- lifestyle (Pender, 1996). The Health Promotion Life-
tation. These studies tested the validity of the HPM style Profile II (HPLP-II), is a revision of the original
(Pender, personal communication, May 24, 2000). A instrument for research. The 52-item, four-point,
†
summary of findings from earlier studies is included Likert-style instrument has six subscales: (1) health
in the 1996 edition of Health Promotion in Nursing responsibility, (2) physical activity, (3) nutrition,
Practice (Pender, 1996). Studies further testing the (4) interpersonal relations, (5) spiritual growth, and
model are discussed in the fifth edition of Health (6) stress management. The mean can be derived for
Promotion in Nursing Practice (Pender, Murdaugh, & each subscale, or a total mean signifying overall health-
Parsons, 2006). The fifth edition includes an emphasis promoting lifestyle (Walker, Sechrist, & Pender, 1987).
on the HPM as applied to diverse and vulnerable The instrument provides assessment of a health-
populations and addresses evidence-based practice. promoting lifestyle of individuals and is used clinically
The rationale for revision of the HPM stemmed by nurses for patient support and education.
from the research. The process of refining the HPM, The HPM identifies cognitive and perceptual
as published in 1987, led to several changes in the factors as major determinants of health-promoting
model (see Figure 21–1) (Pender, 1996). First, im- behavior. The EBBS measures the cognitive and
portance of health, perceived control of health, and perceptual factors of perceived benefits and perceived
cues for action were deleted. Second, definition of barriers to exercise (Sechrist, Walker, & Pender,
health, perceived health status, and demographic 1987). The 43-item, four-point, Likert-styled instru-
and biological characteristics were repositioned as ment consists of a 29-item benefits scale and a 14-item
personal factors in the 1996 revision of the HPM barriers scale that may be scored separately or as a
(Pender, 1996) and the fourth edition of Health Pro- whole. The higher the overall score on the 43-item
motion in Nursing Practice (Pender, Murdaugh, & instrument, the more positively the individual per-
Parsons, 2002) (Figure 21–2). Third, the revised ceives the benefits to exercise in relation to barriers to
HPM (see Figure 21–2) added three new variables exercise (Sechrist, Walker, & Pender, 1987). The EBBS
that influenced the individual to engage in health- is useful clinically for evaluating exercise perceptions.
promoting behaviors (Pender, 1996):
• Activity-related affect
• Commitment to a plan of action Major Assumptions
• Immediate competing demand and preferences The assumptions reflect the behavioral science
The revised HPM focuses on 10 categories of deter- perspective and emphasize the active role of the
minants of health-promoting behavior. The revised patient in managing health behaviors by modifying

*The EBBS can be obtained from the Health Promotion Research Program, Social Science Research Institute, Northern Illinois
University, DeKalb, IL 60115.
† The HPLP-II can be obtained through the faculty-staff profile for Dr. Susan Noble Walker, EdD, RN, at the College of Nursing,
University of Nebraska Medical Center. http://www.unmc.edu/nursing/Health_Promoting_Lifestyle_Profile_II.htm